Seizure frequency in children with epilepsy: factors influencing accuracy and parental awareness
Cigdem Inan Akman1, Maria A Montenegro, Susan Jacob
1Division of Pediatric Neurology, Department of Neurology, Columbia University College of Physician & Surgeons, New York, NY, USA. akman@bcm.tmc.edu
Insights
Parents often under-report seizures in children with epilepsy. Seizure frequency reports are less reliable for young children and those with absence seizures, highlighting the need for video-EEG monitoring.
Area of Science:
- Pediatric Neurology
- Epilepsy Diagnosis
- Clinical Reporting Accuracy
Background:
- Accurate seizure frequency assessment is crucial for epilepsy management in children.
- Clinical reports from parents are a primary source of seizure information.
- The reliability of parental reporting for seizure frequency requires investigation.
Purpose of the Study:
- To evaluate the accuracy of parental clinical reports in determining seizure frequency in children with epilepsy.
- To compare parental seizure reports with objective video-electroencephalography (EEG) monitoring data.
Main Methods:
- Retrospective review of clinical records for 78 children diagnosed with epilepsy undergoing video-EEG monitoring.
- Comparison of parental seizure reports with documented seizures during video-EEG monitoring.
- Statistical analysis to identify factors influencing reporting accuracy.
Main Results:
- A significant proportion of seizures (50%) were under-reported by parents.
- Parental reports demonstrated a sensitivity of 43% and a positive predictive value of 76% for identifying seizures.
- Reporting accuracy was limited in young children and those with absence seizures, but accurate in children with developmental delay or not on anticonvulsant drug (AED) therapy.
Conclusions:
- Parental under-reporting of seizures is common in children with epilepsy.
- Seizure frequency assessment based solely on parental reports should be approached with caution, particularly in specific pediatric subgroups.
- Video-EEG monitoring serves a complementary role to clinical observation for precise seizure frequency evaluation.
Rationale:
The objective of this study was to ascertain the accuracy of clinical reports to determine the seizure frequency in children diagnosed with epilepsy.
Methods:
We reviewed the clinical record of 78 children (January-May of 2006) admitted to the EEG-video monitoring with epilepsy diagnosis. Clinical reports of parents and the files of EEG-video monitoring were reviewed to determine parents' awareness for seizures.
Results:
During video-EEG monitoring, 1244 were recorded on 78 children. Seizures were confirmed in 1095 of which 472 were correctly reported (38%) by parents whereas 623 remained under-reported (50%). Parents' report thus had a sensitivity of 43%, positive predictive value of 76% to identify seizures. Based on the EEG-video monitoring, seizures were reported accurately in 22 (28%) and under-reported in 38 (49%) children. In the under-reported group, none of the seizures were recognized in 10 (13%), only a portion identified in 28 children. The parents' report describing seizure frequency has limited value for young children (p=0.01) and children with absence seizures (p=0.03). However, clinical reports were accurate for the children with developmental delay (p<0.06) or not being on any anticonvulsant drug (AED) therapy (p=0.02).
Conclusion:
Our results indicate that a significant number of seizures remain under-reported by parents of children with epilepsy. The current study underscores that the seizure frequency should be interpreted with caution for young children and children with absence seizures. Video-EEG recording has a complimentary role to the clinical observation for the accurate assessment of seizure frequency in children.
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